Schizophrenia is a neuropsychiatric disorder afflicting about one percent of the population. It is characterized by delusions, hallucinations, disorders in organizing thoughts logically, and emotional withdrawal. There is a well-known tendency for schizophrenia to run in families.
Although the exact pathogenesis of schizophrenia is still not known precisely, a common belief is that excessive activity at dopaminergic synapses in the brain plays a prominent role. To date, a definitive diagnosis of schizophrenia requires a 6-month duration of symptomotology, and relies on heterogeneous symptoms. Because there is neither an effective biological marker for identifying schizophrenia (Willner, 1997; Hietala and Syvalahti, 1996), nor an accurate and rapid diagnosis to ensure more optimal management at an early stage in the illness, there remains a vital need for a convenient assay for diagnosis and follow-up of schizophrenia.
Most of the drugs used to treat schizophrenia act to control the symptoms by neuroreceptor antagonism. Moreover, the dopaminergic basis of schizophrenia is strongly supported by the close correlation between clinical efficacy of antipsychotic medications and their potency to antagonize the binding of dopamine to its receptors (Creese et al., 1976).
Dopamine receptors are divided into two subclasses D1 and D2. The D1 subclass contains the D1 and D5 receptor subtypes, and the D2 subclass contains the D2, D3 and D4 subtypes (Levant, 1997). The dopamine hypothesis of schizophrenia relates specifically to the D2 subclass. Notably, most drugs effective in treating schizophrenia exhibit D2 receptor antagonistic activity, and administration of a selective D1-like antagonist has been reported to result in the worsening of symptoms (Karlsson et al., 1995). Among the receptors in the D2 subclass (D2, D3 and D4), the D3 receptor is located principally in an area of the brain that could be very relevant to schizophrenia, the nucleus accumbens (Willner, 1997). Studies with positron-emission tomography and postmortem brain tissue have indicated increased levels of D2-like dopamine receptors in schizophrenics when compared with nonschizophrenic patients (Seeman and Niznik, 1990). Thus, the level of dopamine receptor could be employed as a marker for schizophrenia if it could be analyzed on an available tissue, preferably a peripheral one.
High affinity binding of dopaminergic ligands, as well as the presence of mRNA of several dopamine receptor subtypes (D3, D4 and D5) in human peripheral blood lymphocytes (PBLs) have been reported in recent years (Ricci et al., 1997, Takahashi et al., 1992). It should be noted, however, that neither D2 nor D1 dopamine receptor subtypes, which are the most abundant receptors in the brain and belong to the D2 and the D1 subclasses, respectively, have been detected in lymphocytes. Although the significance of dopamine receptors, as well as of other neurotransmitter receptors, in lymphocytes is still not clear, it has been suggested that they may reflect corresponding brain receptors. Several studies have demonstrated the increased binding of dopamine antagonists in lymphocytes of schizophrenic patients as compared with healthy individuals (Bondy et al., 1984; Bondy et al., 1985). In addition, a previous study carried out in the laboratory of the present inventors has demonstrated that spiperone (a D2 antagonist) binding in peripheral blood lymphocytes is higher in neuroleptic responders as compared with treatment-resistant schizophrenic patients (Grodzicki et al., 1990). However, the observed differences in binding studies were rather low and often not significant. The discrepancies obtained could have resulted from the crossreactivity of radioligands with different subtypes of the receptor and with other receptors (e.g. serotonergic), and from scattered levels of binding sites. Therefore, such binding assays in lymphocytes may not be suitable for a reliable assay for schizophrenia.
Such a correlation between the status of receptors in the brain and in PBLs has also been demonstrated in Alzheimer's disease, where muscarinic receptors are reduced in both brains and lymphocytes (Ferrero et al., 1991). A previous study by Nagai et al. (1996) demonstrated that patients with Parkinson's disease exhibit reduced levels of D3 receptor mRNA in PBLs, as compared with healthy individuals. These latter findings provide another example of a disease that is associated with an insult in the central nervous system that is reflected in PBLs. This reduction has also been detected in medicated and non-medicated patients.
Central cholinergic systems were also shown to control basic functions of the brain. Acetylcholine mediates synaptic transmission in the vertebrate central nervous system through the activation of two major receptor subtypes, the muscarinic and nicotinic acetylcholine receptors (AChRs). The muscarinic receptors are G-coupled receptors, and the nicotinic receptors are ligand-gated ionic channels. Nicotinic AChRs are composed of five subunits organized around a central ion channel. Neuronal nicotinic AChRs are usually built as heteropentamers, composed of α(α2-α9), and β(β2-β4) subunits. α7, α8, and α9 can function as homomeric AChRs and are of special interest because they bind the curarinetric neurotoxin, α-bungarotoxin. (α-BTXβ). These receptors are characterized by a rapid rate of desensitization, and a high level of selectivity to calcium.
Several recent studies have suggested that nicotinic α7 AChR may be associated with some aspects of schizophrenia (Guan et al., 1999). Nicotine administration normalizes two psychophysiological deficits, typical for schizophrenia: disordered eye movements, and the P50 auditory evoked potential gating deficit (Olincy et al., 1998). The genes responsible for these two deficits are linked genetically to the chromosomal locus (15q14) of the α7-nicotinic receptor gene (Leonard et al., 2000). α7 AChR has been found to be expressed in the mammalian brain, especially throughout the hippocampus (Hellstrom-Lindahl et al., 1999), a brain region associated with schizophrenia.
Interestingly, the vast majority of schizophrenic patients are smoking. They appear to extract more nicotine than normal smokers, possibly due to different inhalation patterns (Olincy et al., 1997). This fact raised the possibility that nicotine might influence the levels of α7 receptor. However, searching for receptor differences between smokers and nonsmokers in the general population did not reveal any significant differences (Stassen et al., 2000).
Association between the α7 nicotinic receptor levels and Alzheimer's disease has also been investigated. Decrease in the expression of α7 AChR was observed in post mortem tissue from Alzheimer's disease patients, exhibiting a reduction of 36% in the hippocampus (Guan et al., 2000). Burghaus et. al. (2000) reported a decrease in protein amount of α7 AChR in Alzheimer's disease cortices. Wang et. al. (2000) described an interaction of α7 AChR and β-amyloid (1-42) as a mechanism involved in the pathophysiology of Alzheimer's disease. There have been some other conflicting reports demonstrating higher levels of the α7 AchR mRNA in the hippocampus (Hellstrom-Lindhal et al., 1999) as well as in lymphocytes (Hellstrom-Lindahl et al., 1997) of Alzheimer's disease patients, compared to healthy controls.
Freedman et al. (2000) reported that interneurons in the hippocampus and in other forebrain structures are decreased in number and function in subjects with schizophrenia. Decreased α7-nicotinic receptor immunoreactivity was found in the frontal cortex and in the nucleus reticularis thalami of schizophrenic patients (Freedman et al., 2000). Court et. al. (1999) described a reduction in the α-BTX binding, and no significant alterations in the nicotine binding in post mortem brains of schizophrenic patients. A significant decrease in the level of α7 AChR was also observed by Guan et. al. (1999) in the frontal cortex of schizophrenics when compared with controls, suggesting that α7 AChR may be involved in inhibitory neuronal pathways engaged in this disorder.